SB 1646 — Health insurance; requiring coverage of medically necessary treatment of mental health and substance use disorders; prohibiting certain limitations; establishing certain utilization review requirements. Effective date.

SENATE CHAMBERFLOOR STATEVERSION OFFebruary OKLAHOMA26, DISPOSITION2026 FLOORAS AMENDMENTAMENDED No.SENATE BILL NO.

________1646 COMMITTEEBy: AMENDMENT (Date) I move to amend Senate Bill No.

1646Gollihare onof Pagethe 5,Senate Linesand 6Lawson throughof 15,the byHouse deleting7 paragraph[ 4health ininsurance its- entirety,mental renumberinghealth subsequentand paragraphs,substance anduse amendingdisorders the- titlebenefits toor conform.coverage - utilization review - criteria - authorizations - policy - rules - codification - effective date ] BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:

SubmittedSECTION by:1.

_______________________NEW SenatorLAW GollihareA Gollihare-CAD-FA-SB1646new 3/25/2026section 8:52of AMlaw (Floorto Amendmentsbe Only)codified Datein andthe TimeOklahoma Filed:Statutes as Section 6060.11c of Title 36, unless there is created a duplication in numbering, reads as follows:

UntimelyA. Amendment Cycle Extended Secondary Amendment

As used in this section:

1.

A “core treatment” for a condition or disorder is a standard treatment or course of treatment, therapy, service, or intervention indicated by generally accepted standards of mental health and substance use disorder care;

2.

“Generally accepted standards of mental health and substance use disorder care” means standards of care and clinical practice that are generally recognized by health care providers practicing in relevant clinical specialties such as psychiatry, psychology, SENATE FLOOR VERSION - SB1646 SFLR Page 1 (Bold face denotes Committee Amendments) addiction medicine and counseling, and behavioral health treatment.

Valid, evidence-based sources reflecting generally accepted standards of mental health and substance use disorder care include published peer-reviewed scientific studies and medical literature and recommendations of nonprofit health care provider professional associations including, but not limited to, patient placement criteria and clinical practice guidelines;

3.

“Health benefit plan” has the same meaning as provided in Section 6060.4 of Title 36 of the Oklahoma Statutes;

4.

“Medically necessary treatment of a mental health or substance use disorder” means a service or product addressing the specific needs of that patient, for the purpose of screening, preventing, diagnosing, managing, or treating an illness, injury, condition, or its symptoms, including minimizing the progression of an illness, injury, condition, or its symptoms, in a manner that is all of the following:

a.

in accordance with the generally accepted standards of mental health and substance use disorder care, b.

clinically appropriate in terms of type, frequency, extent, site, and duration, and c.

not primarily for the economic benefit of the health benefit plan or purchaser or for the convenience of the patient, treating physician, or other health care provider;

SENATE FLOOR VERSION - SB1646 SFLR Page 2 (Bold face denotes Committee Amendments) 5.

“Mental health and substance use disorder” means a mental health condition or substance use disorder that falls under any of the diagnostic categories listed in the mental and behavioral disorders chapter of the most recent edition of the International Statistical Classification of Diseases and Related Health Problems, or that is listed in the most recent version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders or the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood.

Changes in terminology, organization, or classification of mental health and substance use disorders in future versions of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders or the International Statistical Classification of Diseases and Related Health Problems shall not affect the conditions covered by this section as long as a condition is commonly understood to be a mental health or substance use disorder by health care providers practicing in relevant clinical specialties;

6.

“Nonprofit health care provider professional association” means a not-for-profit health care provider professional association or specialty society that is generally recognized by clinicians practicing in the relevant clinical specialty and that issues peer- reviewed guidelines, criteria, or other clinical recommendations developed through a transparent process;

SENATE FLOOR VERSION - SB1646 SFLR Page 3 (Bold face denotes Committee Amendments) 7.

“Utilization review” means prospectively, retrospectively, or concurrently reviewing and approving, modifying, delaying, or denying, based in whole or in part on medical necessity, requests by health care providers, insureds, or their authorized representatives for coverage of health care services prior to, retrospectively, or concurrent with the provision of health care services to insureds, or for out-of-network services required pursuant to 6060.11a of Title 36 of the Oklahoma Statutes;

and 8.

“Utilization review criteria” means any criteria, standards, protocols, or guidelines used by a health benefit plan, or any entity acting on the health benefit plan’s behalf, to conduct utilization review.

B.

1.

Every health benefit plan issued, amended, or renewed in this state that provides hospital, medical, or surgical coverage shall provide coverage for medically necessary treatment of mental health and substance use disorders including services that are consistent with criteria, guidelines, or consensus recommendations from nationally recognized not-for-profit clinical specialty associations of the relevant behavioral, mental health, or substance use disorder specialty.

2.

A health benefit plan shall not limit benefits or coverage for chronic or pervasive mental health and substance use disorders to short-term or acute treatment at any level of care placement.

SENATE FLOOR VERSION - SB1646 SFLR Page 4 (Bold face denotes Committee Amendments) 3.

All utilization review concerning service intensity, level of care placement, continued stay, and transfer or discharge of insureds diagnosed with mental health and substance use disorders shall be conducted in accordance with the requirements of subsection C of this section.

4.

A health benefit plan that authorizes a specific type of treatment by a provider pursuant to this section shall not rescind or modify the authorization or payment after the provider renders the health care service in good faith and pursuant to the authorization for any reason, including, but not limited to, the health benefit plan’s subsequent rescission, cancellation, or modification of the insured’s or policyholder’s contract, or the health benefit plan’s subsequent determination that it did not make an accurate determination of the insured’s or policyholder’s eligibility.

5.

If services for the medically necessary treatment of a mental health or substance use disorder are not available in- network, the health benefit plan shall comply with the out-of- network care requirements provided by Section 6060.11a of Title 36 of the Oklahoma Statutes.